Abstract
Introductionin 2012, the Government of Kenya amended the Food, Drug and Chemical Substances Act to make the fortification of maize and wheat flour with folic acid mandatory. We assessed folate deficiency, awareness and use of folic acid fortified flour among pregnant women receiving antenatal care (ANC) at a clinic at Pumwani Maternity Hospital, Kenya, 2015.Methodswe conducted a cross-sectional survey at Pumwani Maternity Hospital between October and November 2014. We enrolled pregnant women who received ANC and interviewed them using a semi-structured questionnaire after obtaining informed consent. Blood samples were collected from all study participants and serum folate level was analyzed by electrochemiluminescence immunoassay. Folate deficiency was defined as serum folate of < 10nmols/L and borderline folate deficiency was defined as serum folate of between 10nmols/L and 15nmols/L.Resultsamong the 247 study participants, two (1%) had folate deficiency. One hundred and seventy-nine (73.4%) had heard about folic acid, but only 56 (23%) had heard about folic acid fortified flour. Overall, 198 (80%) study participants consumed fortified brands of maize flour and 205 (84%) consumed fortified brands of wheat flour; only four (2%) and two (1%) of study participants consumed specific brands of maize and wheat flour respectively because they were fortified.Conclusionthe prevalence of folate deficiency was low and this may have been because of the availability of fortification programs. Although there was limited knowledge of fortified flour, utilization was high. The Kenyan Ministry of Health should enforce implementation of the legislation on maize flour and wheat flour fortification by all milling industries.
Highlights
Folate deficiency is one of the micronutrient deficiencies of global public health concern, especially among women of child bearing age [1]
Folate deficiency in pregnant women increases the risk of neural tube defects (NTDs), premature births, intrauterine growth retardation, congenital heart defects and oro-facial cleft defects in newborns [2,3]
At the time of the survey, there was no surveillance for neural tube defects but since Birth Defect Surveillance has started in the same hospital, which could allow for future comparisons on the effect of folic acid fortification
Summary
Folate deficiency is one of the micronutrient deficiencies of global public health concern, especially among women of child bearing age [1]. High prevalence of folate deficiency among women of reproductive age were reported in studies conducted before implementation of mandatory fortification of flour in Ethiopia (46%) and Benin (31%) [8,9]. Global data on awareness and utilization of folic acid is limited and is mostly from small studies conducted in various countries. In Nigeria, a high level of awareness (64.6%) about folic acid among pregnant women seeking antenatal care in one of the major hospitals was reported [13]. There is limited information on the level of awareness and utilization of fortified flour in the country, nor is there an estimate of the prevalence of folate deficiency. The study determined the prevalence of folate deficiency and the levels of awareness and use of folic acid among pregnant women seeking prenatal services at a high-volume birthing hospital in Nairobi, Kenya. Those pregnant women with pregnancies of gestational age >28 weeks were excluded from the study
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